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Table of Contents
CASE REPORT
Year : 2018  |  Volume : 12  |  Issue : 3  |  Page : 205-206

Timelines, an important tool for matched unrelated donor stem cell transplant: A case report and review of literature


1 Amity Institute of Biotechnology, Amity University Uttar Pradesh, Noida, Uttar Pradesh; Chimera Transplant Research Foundation, Masjid Moth, South Extension Part-II, New Delhi, India
2 Chimera Transplant Research Foundation, Masjid Moth, South Extension Part-II, New Delhi; Department of Transfusion Medicine, Medanta -The Medicity, Gurgaon, Haryana, India
3 Chimera Transplant Research Foundation; Genebandhu, Masjid Moth, South Extension Part-II, New Delhi, India
4 Amity Institute of Biotechnology ; Amity Center for Cancer Epidemiology and Cancer Research, Amity University Uttar Pradesh, Noida, Uttar Pradesh, India

Date of Web Publication28-Sep-2018

Correspondence Address:
Dr. Girish Sharma
Amity Center for Cancer Epidemiology and Cancer Research, Amity University Uttar Pradesh, Noida, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijot.ijot_18_18

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  Abstract 


Stem cell transplant (SCT) is the “standard of care” for several malignant disorders such as leukemia as well as nonmalignant disorders such as thalassemia and aplastic anemia. In SCT, family (usually a sibling) is screened for human leukocyte antigen (HLA)-matched related donor (MRD), and failing this, matched unrelated donor (MUD) transplants are considered. There are seven major steps involved in the process of MUD SCT, while the patient is prepared for receiving the SCT in parallel after achieving remission. Here, we report the timelines involved in MUD SCT along with a case report and review of literature.

Keywords: Acute myeloid leukemia, matched unrelated donor, stem cell transplant


How to cite this article:
Mishra VC, Tiwari AK, Raina V, Sharma G. Timelines, an important tool for matched unrelated donor stem cell transplant: A case report and review of literature. Indian J Transplant 2018;12:205-6

How to cite this URL:
Mishra VC, Tiwari AK, Raina V, Sharma G. Timelines, an important tool for matched unrelated donor stem cell transplant: A case report and review of literature. Indian J Transplant [serial online] 2018 [cited 2018 Dec 11];12:205-6. Available from: http://www.ijtonline.in/text.asp?2018/12/3/205/242424




  Introduction Top


For the therapeutic treatment of hematopoietic disorders such as leukemia, thalassemia, aplastic anemia, sickle-cell anemia, human leukocyte antigen (HLA)-matched related donor (MRD), or matched unrelated donor (MUD), stem cell transplant (SCT) has been used successfully to save the life of patients.[1] About two third of the patients needed SCT do not have MRD, as India is a vast country with diverse HLA pool due to various division of caste among the existing population.[2] We report the timelines involved in MUD SCT, which was facilitated by Genebandhu[3] stem cell registry in a young female patient, along with a case report and review of literature.


  Case Report Top


A 20-year-old normotensive, nondiabetic female was presented with on and off fever as well as bleeding from gums for the past 1 month. She was evaluated and confirmed to have acute myeloid leukemia (AML) on the basis of bone marrow aspiration, biopsy, and flow cytometry report and was advised to undergo MUD SCT, as no MRD was found. Genebandhu proceeded with the MUD donor search for the patient and found a potential match for her in the German registry through bone marrow donors worldwide (BMDW) search tool.[4] After HLA confirmatory typing (CT) and infectious disease marker (IDM) testing, which was a necessary step subsequent to preliminary search on freshly collected blood sample, the donor was found to be 9/10 matches with C-loci antigen-level mismatch and negative for IDM markers. Transplant center (TC) then decided to go ahead with this donor for further workup. The details of the workup are mentioned in [Table 1].
Table 1: Details of workup schedule

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The stem cell harvest was completed on September 23, 2013, at the donor center (DC) in the respective donor registry, and the total volume of collected stem cells was 452 ml. The CD34+ count of the harvested cells was 7.74 × 106/kg body weight. The harvested stem cell product was then picked from the DC by a trained human courier and dropped at the TC on September 24, 2013. During the transport, harvested stem cell product was maintained in between 2°C and 8°C. To maintain the integrity of the product, a specialized transportation box which maintains the required temperature was used for this courier. After the conditioning treatment, the patient was entered into the remission phase. Subsequently, the harvested stem cell product was given to her through IV catheter similar to a blood transfusion.

She was engrafted with platelets reaching >20,000 for three consecutive days from day +11 and total neutrophil count reaching >500/mm3 at day +13 without any growth colony-stimulating factor (G-CSF) mobilization posttransplant. She was discharged on the 20th day posttransplant without any complications. She was also followed up at regular time intervals including mandatory 30th and 90th day as well as 1st and 2nd year after transplant.


  Discussion Top


AML is a form of cancer that is characterized by an increase in the number of myeloid cells in the bone marrow.[5] Granulocytes and monocytes are collectively called myeloid cells. These cells may cause an abnormal increase in mature myeloid or blast cells, resulting in chronic or acute myelogenous leukemia.[6] One of the treatment options for the AML is SCT. SCT is routinely done with a donor who is a family member known as MRD. However, most of the times, there is no HLA MRD available as a donor. In such patients, MUD transplants are performed worldwide. Globally, there are 75 stem cell registries, with more than 28 million donors registered who have consented to donate hematopoietic stem cells if matched to a patient.[4] Genebandhu has access to voluntary stem cell donors listed with BMDW. There are seven major steps involved in the process of MUD SCT. The process begins with search in registry's own database and in the global database subsequently. The second step comprises HLA CT and IDM which was performed on freshly collected blood samples. The third and fourth steps comprise of “workup” [Table 1] which includes donor counseling and mobilization with G-CSF over 5 days. The fifth step was “harvest” using an apheresis machine at the DC. The sixth step of transporting the harvest was undertaken by a professional human courier from DC to TC in India. The seventh step was “infusion” which constituted confirmation of dose and infusion of collected stem cells (5 × 106/kg body weight) into the patient who was by then in “remission.“


  Conclusion Top


This case report highlights the timelines involved in MUD SCT, which was facilitated by Genebandhu stem cell registry in a young female patient, along with description of the MUD process. It is important for all stakeholders (patient, patient's family, and transplant physician) to understand that there are seven steps involved in the process, and the time spent during all the steps varies from one to several days. In this patient, it took a total of 36 days [Table 2]. The timeline involved in the MUD SCT depends on donor availability. Donor might be in the registry for many years before they are identified as potential match. Therefore, regular contact will be necessary to keep the donor committed to the idea of donation. Keeping registered donor's data up-to-date is one of the key factors for timelines involved in the completion of MUD workup.
Table 2: Timelines followed at various stages in matched unrelated donor transplant

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Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Mukhopadhyay A, Gupta P, Basak J, Chakraborty A, Bhattacharyya D, Mukhopadhyay S, et al. Stem cell transplant: An experience from Eastern India. Indian J Med Paediatr Oncol 2012;33:203-9.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Kumar R. Stem cell transplantation: Indian perspective. J Indian Acad Clin Med 2002;3:182-8.  Back to cited text no. 2
    
3.
Available from: http://www.genebandhu.in. [Last accessed on 2018 Apr 15].  Back to cited text no. 3
    
4.
Available from: https://www.bmdw.org/information/registryinformation. [Last accessed on 2018 Apr 15].  Back to cited text no. 4
    
5.
Löwenberg B, Downing JR, Burnett A. Acute myeloid leukemia. N Engl J Med 1999;341:1051-62.  Back to cited text no. 5
    
6.
Kawamoto H, Minato N. Myeloid cells. Int J Biochem Cell Biol 2004;36:1374-9.  Back to cited text no. 6
    



 
 
    Tables

  [Table 1], [Table 2]



 

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Abstract
Introduction
Case Report
Discussion
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